How Doctors Affect Medical Costs


Could your medical bills climb due to a physician’s lack of experience? A recent RAND Corporation study suggests that physicians with the lowest amount of experience spend a higher amount on treating patients than those with the greatest level of experience. A parallel has been drawn between the characteristics of physicians and health care costs in the first study to make this connection. The results of this study could have a major impact on less experienced physicians, as contracts with provider networks may be made unattainable, or they may receive a payment reduction.

In following the federal health care law, private health insurance companies and public programs are equally required to seek providers who can improve the quality of care for a lower cost. This could prevent new or less experienced doctors from advancing in their careers, or, in the eyes of health reform, prevent the government from spending more money on expensive providers. Researchers involved in the study report the findings are important, but they still require more examination and additional studies. One researcher, Dr. Ateev Mehrotra, stated, “it is possible that one driver of health care costs is that newly trained physicians practice a more costly style of medicine.”

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The Findings

In order to conduct the study, researchers used claims for over 1 million Massachusetts residents enrolled in commercial health plans to make cost profiles for over 12,000 physicians throughout the state, from 2004 to 2005. Medical expenses were measured across 600 different instances where care was sought, including a patient’s illness, how serious their disease may be, and if the doctor performed a procedure.

After this assessment, the results showed physicians with less than ten years of experience charged 13.2 percent more overall than those who have 40 or more years in the field. Cost profiles for physicians who had been working for 10 to 19 years were 10 percent higher, and doctors with 20 to 29 years of experience had costs 6.5 percent higher, those with 30 to 39 years of experience had costs 2.5 percent higher. Therefore, in this instance it appears as though the more years of experience a physician has, the lower their overall costs.

The study also does not imply that physicians with less experience provide better medical care, as little relationship between quality and costs have been found by previous studies. As the study and its findings are in the first stages, researchers acknowledge the need for more studies in order to make a final conclusion. It is emphasized by those who led the study that the findings, as Mehortra said, “underscore the need to better understand physician practice patterns and what influences that behavior.”

 

Why Certain Physicians May Be More Costly

Researchers says that there are various explanations and factors affecting these results. One of which may be the newer physician’s training in more recently developed, hence more costly forms of treatment. It is also a potential factor that a physician with less experience may turn to a more aggressive approach based on their doubt or lack of knowledge. Patients with difficult medical predicaments may also be prone to choosing less experienced doctors, and the way the study is currently run with cost profiles makes it hard to differentiate such circumstances.

The study also suggests that as a newly trained physician continues practicing for years and establishes patient relationships for longer periods, their working patterns could shift and decrease in cost over time. Potentially, cost differences could also stay the same during the course of a newer physician’s career. While the study did not measure the quality of the care provided, it did show that physicians in their first decades of practice may find it more difficult to get business as time goes on.

If more evidence is shown that those with less experience consistently have higher costs throughout the nation, the potential of inclusion in the federally-run health care system is low. The Affordable Care Act strongly states that health plans and hospitals must choose providers who increase the level of quality and decrease costs for patients, insurers, and the government. While this is somewhat hard to find in an expensive field, the government has made efforts to eliminate facilities and doctors who do not fit this mold.

 

Finding a Great Physician on your Health Plan

While these studies may be in the early stages, people with health insurance can still try to choose quality medical providers who will save them money. Every health insurer’s website connects you to a provider search page, and you can research however much information you can find on that physician before you visit them. Clearly, when you stay within your health plan’s network, you will get the greatest amount of savings. The connection between experience and costs may not be completely relevant, even if you do live in Massachusetts, though it is essential to know as much as possible about a doctor or medical professional prior to receiving care.

If you want to take your research a step further, you can look beyond the Google results of their LinkedIn page, resume, and contact information, and get more personal. According to a Consumer Reports survey, the most effective way people found a doctor they had a good experience with was through asking someone they trusted, whether it be a friend, family member, or another physician. A check of credentials is also a smart idea, as your health plan may show a physician’s degrees, certifications, and specialties, but not always the full array of information on their site.

Patients can also check several free and a few paid websites for information on the doctors they wish to use. Free sites include: Administrators in Medicine, which provides details on licensing and disciplinary actions taken against doctors in 18 states, and directs you to the state medical boards of those not included; American Board of Medical Specialties, showing doctors with board certification in a specialty area; and American Medical Association DoctorFinder, which includes the 40 percent of doctors belonging to the AMA.

 

 

 

Sources:

 

1. (2012, November 7). “Link Studied Between Physician Characteristics And Medical Costs.” Medical News Today. http://www.medicalnewstoday.com/releases/252413.php.

2. Consumer Reports. “How to Choose a Doctor.” http://www.consumerreports.org/health/doctors-hospitals/your-doctor-relationship/how-to-choose-a-doctor/getting-started/getting-started.htm.